A systolic blood pressure drop of 12 mmHg during a Symptom-Limited Test occurs without ischemia. What does this indicate?

• A. It may indicate hemodynamic instability, but continuation can be considered if asymptomatic.
• B. The test should continue at the same workload.
• C. This indicates measurement error; ignore.
• D. This indicates a need to increase workload.

Answer: (A)

A fall in systolic blood pressure as workload increases shows the heart can’t maintain adequate perfusion under stress. Even without signs of ischemia, this abnormal BP response points to possible hemodynamic instability or an inadequate cardiac output response. It acts as a warning that the cardiovascular system is struggling, so the test should be approached with caution. If the patient remains truly asymptomatic and the decline is modest with stable vital signs, some clinicians may consider continuing under very close monitoring, but this requires readiness to stop immediately if symptoms develop or the BP drops further. The other options don’t fit because continuing at the same or increased workload would risk worsening perfusion, and ignoring the finding as a measurement error isn’t appropriate when a real, reproducible BP drop has occurred.